Variations in the branching pattern of the celiac trunk and its clinical significance

Abstract

Celiac trunk is the artery of foregut, arising from the abdominal aorta at the level of T12/L1 vertebral body. It extends approximately 1.5 to 2 cm horizontally forwards before dividing into three branches: left gastric, common hepatic, and splenic arteries. Out of the three ventral branches of abdominal aorta, celiac trunk is more prone to have variations. During routine dissection of abdomen for undergraduate students we found some rare variations in the branching pattern of the celiac trunk. Absence of celiac trunk with hepatomesenteric trunk, quadrifurcation with dorsal pancreatic artery arising from it, quadrifurcation with middle colic artery arising from it, left inferior phrenic artery arising from celiac trunk, highly tortuous splenic artery supplying distal 1/3rd of transverse colon and hepatosplenic trunk. Knowledge of such variations is essential for liver and pancreas transplantations, pancreaticoduodenectomy, radiological abdominal interventions, laproscopic surgeries, and in trauma of the abdomen.

Coeliac trunk and its anatomic variations: a cadaveric study

“…These branches are connected to the ventral longitudinal anastomotic channel. Retention or disappearance of parts of this primitive arterial plexus will give rise to variations of the celiac trunk and the superior mesenteric artery [37].…”

Branching pattern variations of the celiac trunk and superior mesenteric artery in a 72-year-old white female cadaver

“…The CT normally originates as the first ventral branch, supplying the foregut (i.e. the stomach, spleen, pancreas, liver, and part of the duodenum) [3,4,7,9,10,12,14,16,18,[24][25][26]33,34,[39][40][41][42]. Venous drainage of the foregut is principally through the portal vein (PV).…”

“…The CT, also known as the coelic artery, coelic axis or truncus coeliakus, usually arises just below the aortic hiatus at the level of the intervertebral disc between the T12 and L1 vertebrae. The CT is normally 1.5 to 2.3 cm long, and its trunk traverses horizontally forward, trifurcating into the LGA, CHA, and SA (55-100% of the population) [1,3,4,[6][7][8][9][10]12,14,16,18,[23][24][25][26]28,29,33,34,[39][40][41][42][43][44]. This trifurcation was first described by Haller in 1756 as tripus Halleri [7,8,18,21,22,24,28,30,35,45,46].…”

“…In addition to an extensive literature on origin variation, there is a substantial literature pertaining to branching pattern variation of the CT. To identify a vessel as a CT, two of the three major branches must be present ( [45]. These branch variations include: GDA (3.61%, 3.3%, 0.2%, 1.7% of cases) [20,30,49] inferior phrenic arteries (13%, 28.2%, 30-51%) [32] left or right middle suprarenal artery (3.3%) [54] left superior suprarenal artery [3] left middle suprarenal artery [3] dorsal pancreatic artery [9] RHA [4] accessory hepatic artery and retroportal artery [55] MCA (1.2-4.8%) [42]. Generally, these branch variations manifest in place of or in addition to the usual branches of LGA, CHA, and SA, and are known as replaced (aberrant) or accessory [3].…”

“…Makisalo et al (1993) and Raviprasanna and Kulkarni (2018) reported one case in each of their cohorts that had an accessory LHA arising from the CT [45,56,57]. In its absence (0.38-1.4%), branches of the CT may arise from the aorta [4,7,8,27,28,34,35,38,[42][43][44]58].…”